Treatment of Gustatory Sweating with Botulinum Toxin: Special Aspects

Abstract

Botulinum toxin treatment is an efficient, well-tolerated technique for patients suffering from gustatory sweating, first described by our group. With the experience gained in recent years we were able to improve on some of our skills in the diagnosis and treatment of gustatory sweating and here we wish to focus on some interesting aspects: (1) the necessity for an exact anamnesis before treatment with botulinum toxin to ensure correct treatment; (2) the advantages of Minor`s test in special situations, for example, when sweating occurs in regions of hairy skin, retroauricular, at the back of the auricle and in areas distant from the site of salivary gland surgery; (3) the reduction of pain during treatment using an anesthetic ointment containing lidocaine and prilocaine as active substances; (4) intracutaneous injections in areas anterior to the fascia-protected skin of the lateral face-covering mimetic muscles, and (5) the occasional necessity for short-time reinjection in small areas of persistent sweating.

Efficacy and safety of botulinum toxin type A for treatment of Frey's syndrome: evidence from 22 published articles

“…The remaining 84 were considered potentially eligible and their full‐text articles were screened. After serious scrutiny for eligibility, 22 articles including 23 studies met our inclusion criteria and were included for our study (Fig. ).…”

Minimally Invasive Application of Botulinum Toxin Type A in Nasal Hypersecretion

“…Botulinum toxin type A has been used in the therapy of muscular disorders [3] and dysregulation of the autonomic nervous system [4,5]. Botulinum toxin has been injected into the turbinates of patients with intrinsic rhinitis, causing a significant reduction of nasal hypersecretion [2]; in dogs, a gauze soaked with the toxin and introduced into their nostrils was able to reduce rhinorrhea [6].…”

Pain Sensation during Intradermal Injections of Three Different Botulinum Toxin Preparations in Different Doses and Dilutions

“…5,7 Cryoanalgesia before injection, anesthetic ointment, EMLA cream, spray-type anesthetics, and lidocaine tape are effective in periinjectional anesthesia. 6,8,16,17 In the treatment of palmar hyperhidrosis, however, external topical application of local anesthetics did not reduce injection pain. 9 Painless injections were only possible after local median and ulnar nerve block or intravenous regional anesthesia.…”

“…Benzyl alcohol–containing saline (preserved saline) for reconstitution of BoNT/A and B was seen to mitigate injection pain 5,7 . Cryoanalgesia before injection, anesthetic ointment, EMLA cream, spray‐type anesthetics, and lidocaine tape are effective in peri‐injectional anesthesia 6,8,16,17 . In the treatment of palmar hyperhidrosis, however, external topical application of local anesthetics did not reduce injection pain 9 .…”